When Can I Return to Exercising? The Timeline of Rotator Cuff Rehab – Advanced Phase (Weeks 12-26)
It’s been three months since your rotator cuff surgery and hopefully your rehab timeline was on par with the average timeline. If all went to plan, you worked on passive shoulder range of motion, scapular isometrics and elbow/wrist active ROM during the early phase (weeks 1-6) and shoulder active range of motion, scapular strengthening and rotator cuff isometrics during the intermediate phase (weeks 6-12).
You’ve finally made it to the advanced phase of rotator cuff rehab and this is the most FUN of them all!! The goals during this phase are:
- Maintain full non-painful active ROM
- Improve scapular and glenohumeral muscular strength, endurance and power
- Gradual return to full functional activities (week 16)
- Gradual return to strenuous work activities (week 20)
- Gradual return to recreational and sport activities (week 26)
Now go ahead and ask that question you’ve been asking since week 1 again: “when can I go back to the gym, tennis, swimming, golf, baseball, aerobics class, or that other favorite weekend activity?”
And the answer! You will most likely be able to start working your way back to these activities or modified versions of them starting around week 16-26. The collagen fibers in the scar tissue that formed from the surgery has now formed a relatively strong connection from the rotator cuff tendon to the bone, and they can now begin to tolerate some light resistance training!
You should of course consult with your surgeon and physical therapist before beginning any resistance training or recreational activity. They have the knowledge of the extent of your injury, monitored your progress and know the stress that specific activities will place on the tendons of the rotator cuff. At week 12, the strength of the tendon attachment is still not ready for strong resistance or plyometric activities, but actually needs some light resistance to ensure continued healing and remodeling to the tissues.
A gradual progression from light resistance bands, to light weights, to heavy weights is still needed to protect the tissues and your physical therapist will be able to help develop an appropriate exercise plan tailored just for you. Remember, it takes 6-9 months for the tendon to gain full strength in its attachment to the bone; even then, the time to return to play may be even longer for certain athletes who play a sport that demands rapid and vigorous motions from the rotator cuff. The average time to return to play for MLB pitchers is often 17 months!
During week 12, you will most likely be given light resistance exercises to perform with a resistance band and work your way to a gentle resistance program with weights at the gym. During week 16, you will begin to lift heavier weights at the gym and start a slow progress to your previous level of activity. Pain should be your guide on what weight is appropriate to perform and of course your PT can help design a plan on how quickly to progress on a week to week basis.
Depending on your strength, shoulder mechanics and if you have any pain with your resistance program, your PT will gradually start to clear you for recreational activities around week 16. First, you will be cleared for full strength training of the lower extremity where you don’t have to pick up heavy weight, as well as recreational activities that are less demanding on the rotator cuff such as cycling, running, chip and putting and easy swimming.
Around 6 to 9 months out, overhead athletes will be cleared for a gradual return to their sport. These will include sports that place a high demand on the rotator cuff tendon such as: tennis, baseball, volleyball, javelin or discus throwing, squash, frisbee, swimming and golf.
Remember that everyone progresses at a different level and while very few people will progress faster than this timeline (due to tissue healing times), it may take longer for many people to progress to pain free sports and activities. The hard work you put into your rehabilitation is definitely worth it when you get the results you want, so don’t worry about the timeline too much and just keep working hard towards your goals!
Hopefully this blog series gives you a better perspective on what to expect when recovering from a rotator cuff repair. The therapists here at Competitive Edge Physical Therapy love educating clients on the most up-to-date evidenced based treatment options and creating a community where people can ask and get answers online. If you have any specific questions regarding shoulder rehab, or would like help making informed decisions about your health, contact us at Competitive Edge Physical Therapy for a free consult!